Lung cancer MDT quality assessment: A nationwide study.

person Janna Berg Vestfold Hospital Trust, Tønsberg, Norway info_outline Janna Berg, Christina Aamelfot, Siv-Gyda Aanes, Marit Wilskow, Maria Moksnes Bjaanæs, Odd Terje Brustugun, Sverre Fluge, Per Andersen Flåtten, Bjorn Henning Gronberg, Terje Skraastad, Rene P van Helvoirt, Martin Petersen, Rune Tilseth, Torben Riis Rasmussen, Kirill Neumann

Authors person Janna Berg Vestfold Hospital Trust, Tønsberg, Norway info_outline Janna Berg, Christina Aamelfot, Siv-Gyda Aanes, Marit Wilskow, Maria Moksnes Bjaanæs, Odd Terje Brustugun, Sverre Fluge, Per Andersen Flåtten, Bjorn Henning Gronberg, Terje Skraastad, Rene P van Helvoirt, Martin Petersen, Rune Tilseth, Torben Riis Rasmussen, Kirill Neumann Organizations Vestfold Hospital Trust, Tønsberg, Norway, Haukeland University Hospital, Bergen, Norway, Nordland Hospital, Bodø, Norway, Nordlandssykehuset, Bodø, Norway, Department of Oncology, Oslo University Hospital, Oslo, Norway, Oslo, Norway, Section of Oncology, Drammen Hospital, Vestre Viken HF, Drammen, Norway, Department of Pulmonology, Haugesund Hospital, Haugesund, Norway, Vestre Viken Hospital Trust, Kongsberg, Norway, Norwegian University of Science and Technology (NTNU), Trondheim, Norway, Hospital of Southern Norway, Kristiansand, Norway, Stavanger University Hospital, Stavanger, Norway, Førde Hospital Trust, Førde, Norway, Department of Pulmonary Medicine, Aarhus University Hospital, Aarhus, Denmark, Akershus University Hospital, Lørenskog, Norway Abstract Disclosures Research Funding Vestfold Hospital Trust Background: This observational study evaluates concordance between lung cancer multi-disciplinary team (MDT) meetings, focusing on diagnosis, staging, and treatment recommendations, especially for curative options. Assessing MDT decisions aims to identify factors potentially affecting survival rates, promoting equal treatment access for patients nationwide. Methods: In Norway, patients with lung cancer are discussed at local MDT (without a thoracic surgeon present) and at university hospital MDT (with a thoracic surgeon present). All hospitals received 35 fictitious case reports of patients with inoperable non-small cell (NSCLC) and small cell lung cancer (SCLC) with anonymized CT and PET images for discussion at the ordinary MDT meetings. Of the 12 participating hospitals, 5 were university hospitals. Results: Of the 35 patient’s cases, 12 were assessed as having stage III NSCLC. For 10 of the 12 there were differences in stage assessment, from stage IIIA-B-C to IV, and in recommended treatment (Table). For each case, curative treatment was recommended by a varying number of MDTs, from zero to nine of 12. Treatment suggestions for the four SCLC patients were identical except for one patient with stage IV, performance status (PS) score 2-3 and stroke, for whom the recommended treatment ranged from best supportive care (BSC) to triple therapy. There was generally good consensus between recommending treatment with a tyrosine kinase inhibitor (TKI) in patients with epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) translocation positivity. We found that factors leading to discrepancies in MDT decisions were patients age >75-80 years, comorbidities, PS 2 or lack of a stated PS, PD-L1 more than 50-75% in stage IV and large cell neuroendocrine carcinoma (LNEC). Conclusions: MDT-recommendations regarding treatment varied between MDT sites, and this may have the greatest consequences for patients in stage III. MDT treatment recommendations varied between the sites, confirming that treatment choice can be challenging in certain type of cases like elderly, poor PS or LNEC. Shared decision-making (SDM) with patients was often recommended. As an important outcome of the study, we found no difference in treatment choice between local and university hospital MDTs. Proposed stage IIIA-B-C or IV NSCLC, and recommended treatment. Case 1 2 3 4 5 6 7 8 9 10 11 12 Age 64 81 64 72 72 73 60 63 65 78 78 75 PS 1-2* 2 1* 2* 1* 3 3* 1 0-1* 2 2* 3 Histology Ac Ac Sqc NSCLC Sqc Sqc Sqc Sqc Ac LNEC Sqc Ac PD-L1 >50% 1-50% 1-25% >50% >50% <1% <1% >50% >50% >50% 1-50% Stage IIIB-IV III-IV IIIA-B-C IIIB-C-IV IIIA-B-IV IIIA IIIC-IV IIIC IIIC -IV IIIA-IV IIIB-C IIIA-IVB MDT recommended further examination 5 of 12 6 of 7 1 of 12 2 of 12 1 of 12 6 of 12 MDT-recommended curative treatment 0 of 12 1 of 12 8 of 12 9 of 12 4 of 7 0 of 7 0 of 11 3 of 12 5 of 12 1 of 12 4 of 12 8 of 12 Ac: Adenocarcinoma; Sqc: Squamous cell carcinoma; PS*: Assumed PS score.